Food intake during the previous 24 h as a
percentage of usual intake: a marker of hypoxia
in infants with bronchiolitis: an observational,
prospective, multicenter study
François Corrard
, France de La Rocque
, Elvira Martin
, Claudie Wollner
, Annie Elbez
, Marc Koskas
Alain Wollner
, Michel Boucherat
and Robert Cohen
Background: Hypoxia associated with bronchiolitis is not always easy to assess on clinical grounds alone. The aim
of this study was to determine the value of food intake during the previous 24 hours (bottle and spoon feeding), as
a percentage of usual intake (24h FI), as a marker of hypoxia, and to compare its diagnostic value with that of usual
clinical signs.
Methods: In this observational, prospective, multicenter study, 18 community pediatricians, enrolled 171 infants,
aged from 0 to 6 months, with bronchiolitis (rhinorrhea + dyspnea + cough + expiratory sounds). Infants with risk
factors (history of prematurity, chronic heart or lung disorders), breast-fed infants, and infants having previously
been treated for bronchial disorders were excluded.
The 24h FI, subcostal, intercostal, supracostal retractions, nasal flaring, respiratory rate, pauses, cyanosis, rectal
temperature and respiratory syncytial virus test results were noted. The highest stable value of transcutaneous
oxygen saturation (SpO2) was recorded. Hypoxia was noted if SpO2 was below 95% and verified.
Results: 24h FI ≥ 50% was associated with a 96% likelihood of SpO2 ≥ 95% [95% CI, 91–99]. In univariate analysis,
24h FI < 50% had the highest odds ratio (13.8) for SpO2 < 95%, compared to other 24h FI values and other clinical
signs, as well as providing one of the best compromises between specificity (90%) and sensitivity (60%) for
identifying infants with hypoxia. In multivariate analysis with adjustment for age, SpO2 < 95% was related to the
presence of intercostal retractions (OR = 9.1 [95% CI, 2.4-33.8%]) and 24h FI < 50% (OR = 10.9 [95% CI, 3.0-39.1%]).
Hospitalization (17 infants) was strongly related to younger age, 24h FI and intercostal retractions.
Conclusion: In practice, the measure of 24 h FI may be useful in identifying hypoxia and deserves further study.
Keywords: Bronchiolitis, Hypoxia, Feeding, Infant, Out-patient, Intercostal retraction, Subcostal retraction,
Supracostal retractions, Respiratory syncytial virus
* Correspondence:
ACTIV (Association Clinique et Thérapeutique Infantile du Val de marne), 27
rue d’Inkermann, 94100, Saint Maur des fossés, France
Full list of author information is available at the end of the article
© 2013 Corrard et al.; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative
Commons Attribution License (, which permits unrestricted use, distribution, and
reproduction in any medium, provided the original work is properly cited.
Corrard et al. BMC Pediatrics 2013, 13:6
Bronchiolitis is the most common viral infection of the
lower respiratory tract in infants under 1 year of age [1].
It affects more than 400 000 infants every year in France
[2] and is responsible for tens of thousands of hospital
admissions. Respiratory syncytial virus (RSV) is usually
responsible for the first episode, but other viruses may
also be involved. Bronchiolitis is usually mild, resolving
spontaneously within a few days, but some infants, espe-
cially the very young, develop severe forms with hypoxia
and may need hospitalization, primarily for supplemental
oxygen administration. Treatment is solely symptomatic,
and recent studies have shown that physiotherapy is not
beneficial [3,4]. Diagnosis of this infection is often easy,
but its severity (hypoxia due to broncho-bronchiolar
obstruction) may be difficult to assess. Suckling is a
muscular effort that must be coordinated with breathing,
and this is more difficult when breathing is restricted by
airway obstruction, therefore, reduced feeding might
represent a marker of severity.
The amount of food ingested in the past 24 hours is
relatively easy to measure accurately, whether taken
exclusively from a (graduated) bottle or partly by spoon.
Hypoxia can be diagnosed by non-invasive transcutane-
ous measurement of oxygen saturation (SpO2). Although
many inexpensive devices are available, few are suitable for
young infants, who require specific, often costly probes that
can be difficult to disinfect. In addition, isolated SpO2
values may not be predictive of subsequent outcome.
The aims of this study were to determine whether food
intake in the previous 24 hours, expressed as a percentage
of usual intake (24h FI), might serve as an initial screening
tool for hypoxia in infants with bronchiolitis, and to
analyze the relation between both 24h FI and standard
clinical signs and the decision to hospitalize the infant.
This tool might be useful for telephone triage or in settings
where the history can be used to guide further evaluation.
Patients and methods
This observational, prospective, multicenter study included
infants aged from 0–6 months diagnosed with bronchiolitis
(rhinorrhea + cough + dyspnea + expiratory breath sounds)
during the three winter months (November to January)
when the infection is most frequent in Europe. Infants
were excluded if they had risk factors (history of prematu-
rity, chronic heart or lung disease), were breast-fed (even
partially), or had previously received treatment for a
bronchial disorder (bronchodilators, corticosteroids,
physiotherapy). Infants cared for outside the home by
child minders could be enrolled, provided the parents
knew the precise amount of food ingested in the previous
24 hours. Food intake was calculated as the sum of bottle
and spoon feeding. The infants were recruited by 18
community pediatricians in the Paris region.
Data collection
The pediatrician noted the infant’s age, the duration (days)
of wheezing, any fever or loose stools in the previous 24
hours, the usual type of feeding, the number of meals taken
with a bottle or spoon, and the amount of formula-milk
usually drunk, per meal, then calculated the total volume of
milk taken over the past 24 hours. If the baby was partly
spoon-fed, the pediatrician noted any change in the amount
ingested during the previous 24 hours compared to normal.
Quiet, non crying infants were examined for retrac-
tions (subcostal, intercostal, suprasternal, and nasal flaring),
the respiratory rate (recorded for one minute; rapid if
>50/min), cyanosis, and respiratory pauses (during the
examination or reported by the parents). SpO2 was
measured only after collecting this information, in order
not to interfere with the clinical examination. Rectal
temperature was routinely measured.
The pediatricians used a Hellcor pulse oximeter to
measure SpO2. The prolonged measurements took into
account the pulsatile nature of arterial flow (displayed on
the device), as well as the highest SpO2 value recorded
(sources of error tend to give lower results) and its stability.
Hypoxia was defined as an SpO2 below 95%. All results
below< 95% were verified by a second measurement, and
only the highest value was recorded.
RSV was sought routinely (immunochromatographic
screening test VRSTOP+
(ALL.DIAG SA, Strasbourg,
France) with nasal swabs).
The doctor recorded the decision regarding immediate
hospitalization. The hospital reports were recovered later
to determine whether the child had received specific
hospital care (oxygen, infusion, or gastric gavage).
Statistical analysis
The sensitivity, specificity, positive predictive values (PPV),
negative predictive values (NPV), positive likelihood ratios
) and negative likelihood ratios (LR
) were calculated
with their 95% confidence intervals, taking an Sp02
of < 95% as reference, and ROC curves were computed.
Means were compared between groups by using a t-test
with an unequal variance option if necessary, and percen-
tages were compared by using the chi2 test or Fisher's
exact test, as appropriate. Significance was assumed at
p < 0.05. Univariate and multivariate analyses (logistic re-
gression) were used to identify factors associated with
SpO2 < 95% after adjustment for age (< or ≥ 2 months), and
odds ratios (OR) were calculated with their 95%CI. Stata SE
9.1 statistical software was used.
A poster placed in the waiting room invited parents to
participate in the study and informed them that they were
free to refuse their participation. They were informed that
the study was anonymous and would have no influence
Corrard et al. BMC Pediatrics 2013, 13:6 Page 2 of 7
on the care received by their child. Furthermore, before
enrolment, the investigators informed the parents about
the purpose of the study and requested their oral consent.
During the period in which this observational study
was performed, French legislation did not require
ethical approval or other authorizations for research
not involving unusual or additional procedures relative
to usual practice.
During three winter periods, from late 2006 to early
2009, the participating pediatricians recruited 171
infants with a mean age of 1.6 ± 3.7 months (median 4
months). The infants were seen between the first and
sixth day after the onset of chest sounds (average 2 days,
±1.5 days), as reported by the parents.
During the previous 24 hours, 22% of the infants had
been febrile (≥ 38°C) (21% were febrile at the time of the
examination), and 14% had had three or more loose stools.
Feeding consisted exclusively of formula-milk in 87%
of infants, while the remaining 13% of infants, all aged
more than 4 months, were partly spoon-fed. Food intake
in the previous 24 hours (24h FI), as a percentage of the
usual amount, was less than 50% in 14% of cases, ≥ 50%
to < 70% in 26% of cases, and ≥ 70% in 60% of cases.
Nasal flaring and suprasternal, intercostal or subcostal
retractions were present in respectively 2%, 15%, 25% and
30% of infants.
The respiratory frequency was ≥ 50/min in 43% of
infants and ≥ 60/min in 23% of infants.
Cyanosis was noted in 5 infants, one of whom also
had breathing pauses.
Mean oxygen saturation was 98% ± 3% (80% to 100%;
median 98%). Fifteen infants (9%) had SpO2 < 95% and 2
infants had SpO2 < 90%.
RSV was tested for in 104 infants, of whom 42% were
Seventeen of the 171 infants were hospitalized imme-
diately after the examination. Ten of the hospitalized
infants received specific hospital care, consisting of oxygen
in 9 cases, gastric gavage in 6 cases and infusion in 5 cases.
Relation between SpO2 and 24h FI
The closer food intake in the previous 24 hours was to the
usual amount, the closer SpO2 was to normal: higher 24h
FI values were associated with higher SpO2 (Figure 1).
The average SpO2 ininfants whose food intake fell by
more than 50% was 95.5% [95% CI, 93.6-97.4%], compared
to 98.1% [95% CI, 97.7-98.3%] in the infants whose food
intake remained higher than 50% of normal (p < 0.001). In
the latter group, SpO2 was normal (≥ 95%) in 96% of cases
[95% CI, 91-99%].
When food intake during the previous 24 hours was
50% or more of the usual amount, the likelihood that
saturation would be normal (SpO2 ≥ 95%) was 96%
[95% CI, 91%-99%].
Relation between SpO2, clinical status and food intake
The positive predictive values (PPV) of 24h FI for SpO2
< 95% were highest with cutoffs of < 40% and < 50%
(Table 1). However, 24h FI < 50% had the highest specificity
(90%) and moderate sensitivity (60%) (Figure 2), and also
the highest odds ratio of all 24h FI cutoffs in univariate
analysis (Table 1).
In multivariate analysis, the only variables significantly
associated with SpO2 < 95% after adjustment for age
were intercostal retraction (OR = 9.1 [95% CI 2.4 to
33.8]) and 24h FI < 50% (OR = 10.9 [95% CI 3.0 to 39.1]).
24h FI and hospitalization
The 17 hospitalized infants had significantly lower SpO2
values (94% ± 5% versus 98% ± 2%, p < 0.005) and signifi-
cantly lower 24h FI values (56% ± 24% versus 76 ± 19%,
p < 0.0003) than the non-hospitalized infants.
Nine of the 17 hospitalized infants (Table 2) had both
24h FI < 50% and SpO2 < 95%, while 24h FI was ≥ 50% in
90% of the non-hospitalized infants (p < 0.001). Six hospi-
talized infants had 24h FI > 50% and no obvious signs of
respiratory distress, but all were very young (< 2 months).
Four of these six infants did not require specific hospital
care. The fifth child had a 24h FI value very close to the
cutoff (52%), with rapid breathing, intercostal retractions
and an SpO2 of 92%. The sixth child had a 24h FI of
67% and an SpO2 of 92%, but also had high fever
(39.6°C) during the previous 24 hours and rapid
breathing (55 breaths/min), probably due to fever. This
infant did not require specific hospital care.
In multivariate analysis, the decision to hospitalize was
very strongly associated with Sp02 < 95% (p < 0.0001) and
age < 2 months (p = 0.001), but not with the other para-
meters. However, when saturation was excluded, the deci-
sion to hospitalize was strongly associated with age < 2
months (OR = 14.7 [95% CI 3.1 to 69.8]), 24h FI < 50%
(OR = 10.6 [95% CI 3.0 to 37.3]) and intercostal retractions
(OR = 3.4 [95% CI 1.0 to 11.4]). Thus, if SpO2 measure-
ment had not been available, the decision to hospitalize
could have been based on age < 2 months, 24h FI < 50%,
and intercostal retractions.
This study suggests that recent changes in food intake by
infants with bronchiolitis closely reflect their oxygenation
status. The 24h FI cutoff most strongly associated with
hypoxia (odds ratio = 13.8 [4.3 to 44.1]) was 50% of the
usual amount, and this cutoff also had high negative pre-
dictive value. In the study population, there were 14
infants who took less than 50% of their usual food intake,
and only one of them was not hypoxic. This 50% cutoff
Corrard et al. BMC Pediatrics 2013, 13:6 Page 3 of 7
also represented the best compromise (moderate sensiti-
vity, high specificity) for identifying infants with SpO2
< 95%. In addition, multivariate analysis showed that this
parameter remained correlated with SpO2 < 95%, even
after adjustment for age and intercostal retractions, while
the other clinical and biological parameters showed no
significant correlation with SpO2. This cutoff (50%) would
have two advantages. First, if food intake during the past
24 hours remains more than half the usual amount, the
likelihood of normal oxygenation status is 96% (or at least
91%, the lower limit of the confidence interval), indicating
that bronchiolar obstruction is well tolerated and that
pulse oximetry is probably unnecessary in the absence of
associated gravity signs. In contrast, food intake below
Table 1 Sensitivity, specificity, PPV, NPV, LR
, LR
and odds ratios of clinical signs of hypoxia (SpO2 < 95%) in infants
with bronchiolitis
Sensitivity %
[95% IC]
Specificity %
[95% IC]
[95% IC]
[95% IC]
[95% IC]
[95% IC]
Odds ratio n
[95% IC]
Suprasternal retraction 50 [21–79] 87 [81–92] 24 [9–45] 96 [91–98] 4 [2-8] 0,6 [0.3 - 1] 6.9 [2.0 - 23.7]
Intercostal retraction 73 [45–92] 80 [73–86] 26 [14–42] 97 [92–99] 3.6 [2-6] 0.3 [0.1 - 78] 10.8 [3.2 - 36.3]
Subcostal retraction 47 [21–73] 72 [64–79] 14 [6–27] 93 [87–97] 1.7 [0.9 - 3] 0.7 [0,5 – 1.2] 2.3 [0.8 - 6.6]
Polypnea (≥ 50/min) 87 [60–98] 62 [53–70] 19 [10–30] 98 [93–100] 2.3 [1.7 - 3] 0.2 [0.06 – 0.8] 10.5 [2.3 - 48.2]
24h FI < 70% 87 [60–98] 65 [56–72] 19 [11–31] 98 [93–100] 2.4 [1.8 – 3.2] 0.2 [0.06 – 0.8] 11.8 [2.6 - 54.2]
24h FI < 60% 67 [38–88] 78 [70–84] 23 [11 \- 38] 96 [91–99] 3 [1.9 – 4.7] 0.4 [0.2 – 0.8] 6.9 [2.2 - 21.7]
24h FI < 50% 60 [32–84] 90 [84–94] 38 [19–59] 96 [91–99] 6.1 [3-11] 0.4 [0.2 – 0.8] 13.8 [4.3 - 44.1]
24h FI < 40% 33 [12–62] 96 [92–99] 46 [17–77] 94 [89–97] 8.5 [2.9 - 24] 0.7 [0.5 – 0.99] 12.2 [3.2 - 47.2]
24h FI food intake in previous 24h as a % of usual intake; PPV positive predictive value ; NPV negative predictive value ; LR
positive likelihood ratio ; LR
likelihood ratio; [95% CI] 95% confidence interval.
Figure 1 Mean SpO
values according to food intake in the previous 24 h (as a percentage of usual intake). The three left-hand
rectangles show that mean SpO2 values vary in the same direction as 24 h % food intake. The first and last rectangles show the significant
difference in mean SpO2 values between infants who took < 50% or ≥50% of their usual volume of food in the previous 24 h (4 missing data).
Length of the rectangles according to the 95% confidence intervals.
Corrard et al. BMC Pediatrics 2013, 13:6 Page 4 of 7
50% of normal calls for pulse oximetry and medical
This 50% cutoff has a certain tolerance: if 24h FI is
40%, then the negative predictive value only falls from
96% to 94% and the odds ratio from 13.8 to 12.2. The
clinical implications therefore remain valid.
24h FI might be used as a screen to further testing. This
might be useful for telephone triage or other settings
where the history can be used to guide further evaluation,
as monitoring a bronchiolitic child in the home.
Food intake has already been included in severity
scores and guidelines, but only as “reduced or normal”
[2,5-7], or “good, reduced or poor” [8-10]. The November
2006 Scottish guideline [11] mentioned a < 50% reduction
in fluid intake in the previous 24 hours as a gravity sign,
but this was based on expert opinion and not on
published research.
Physiological studies of milk intake by infants with
bronchiolitis [12] have shown that the number of sucking
and swallowing actions is the same as in healthy infants,
but that milk flow during these two movements is
reduced. In addition, swallowing movements are followed
less by expiration and more by inspiration, and periods of
apnea are twice as frequent after swallowing. Suckling is a
muscular effort that must be coordinated with breathing,
and this is more difficult when breathing is restricted by
airway obstruction, when the child is tired, and when the
muscles lack oxygen [13].
Parents are generally aware of the amount of food
their infant usually consumes, and can accurately recall
food intake in the previous 24 hours, based on the
amount prepared and the amount left, especially when
their child is sick. Indeed, parents prepare the same
Figure 2 Roc curve : Compromise sensibility / specificity for different values of 24h FI.
Table 2 Factors associated with hospitalization for
(n = 17)
Non hospitalized
(n = 154)
n % n % p
Age < 2 months 13 76% 7 5% < 0.001
24h FI < 50% 9 53% 15/150 (*) 10% < 0.001
Intercostal retraction 9 53% 33/151 (*) 22% < 0.005
1 or more of these 3 factors 14 82% 49/147 (*) 33% < 0.001
SpO2 < 95% 11 65% 4 3% < 0.001
* missing data.
Corrard et al. BMC Pediatrics 2013, 13:6 Page 5 of 7
quantity of milk (powder scoops and bottle graduations)
each day for a given meal. The amount left in the bottle by
healthy infants does not vary much, but increases during
bronchiolitis. Thus, in practice, 24-hour percentage food
intake is easy to calculate.
In theory, SpO2 would be an accurate marker of hyp-
oxia, which is directly related through the hemoglobin
dissociation curve. Hypoxia is the main complication of
bronchiolitis. However, SpO2 is tricky to measure, re-
quiring a considerable period of calm, and a correctly
recorded arterial pulse. Correct sensor positioning may
take several attempts. In addition, pediatric sensors are
fragile, difficult to disinfect correctly, and expensive for
single use. In the range of values generally measured in
this setting (85-100%), a small change in SpO2 is asso-
ciated with a large change in PaO2. The result is also
observer-dependent and may vary over a 30-minute inter-
val [14]. This is why we verified all values below< 95% by
a second measurement, and only used the highest value.
The 95% SpO2 cutoff is commonly used to define
hypoxia, and oxygen therapy is recommended if SpO2
is < 90% for a prolonged period in an infant not at
risk (term birth, no heart or lung disease and age
more than 3 months) [5].
Among the three types of retraction (suprasternal, inter-
costal and subcostal), intercostal retractions were most
closely associated with SpO2 < 95%. Wang [13] reported
that the appreciation of retractions is observer-dependent,
even when the observer is a healthcare professional, and
that the appreciation may vary between two separate
observations made 10 to 30 minutes apart. The degree of
retractions is difficult to quantify, especially in borderline
situations. In addition, they are difficult for parents to
assess without specific training. Retractions are included in
most scores, but these are not always easy to use in daily
practice. Measurement of 24 hours percentage food intake
seems to be far simpler for parents.
Hospitalization was associated with hypoxia and with age
< 2 months (French guidelines recommend hospitalization
of all bronchiolitic infants less than 6 weeks old). Hypoxia
was associated with 24h FI < 50% and intercostal retrac-
tions. In the physician’s office, if SpO2 cannot be measured,
these two signs, especially 24h FI < 50%, in addition to age,
can help to decide whether hospitalization is necessary.
This study may have certain limitations. First, the same
pediatrician assessed all the data (24h FI, clinical signs of
respiratory impairment, oxymetry) and took the decision
regarding hospitalization. We tried to limit the subjective
element by establishing the order of data collection and
applying precautions during oxymetry.
Second, these results are applicable to patients presenting
to community practices. Further studies of sicker infants
(emergency departments, hospital inpatients) would be
necessary to determine whether 24h FI remains valid in this
population. It should be noted that most studies of severe
adverse outcomes in this setting have involved inpatients,
which limits their relevance to other situations [5]. Finally,
we excluded breast-feeding infants, as the amount of milk
ingested could not easily be estimated, notably from the
suckling time [15].
We studied the semiological value of a clinical sign for
assessing the severity of bronchiolitis in previously
healthy, mainly bottle-fed, full-term infants presenting to a
pediatrician’s office.
Food intake during the previous 24 hours, as a per-
centage of usual intake, was predictive of oxygenation
status (hypoxia or normoxia), and is easy for parents to
memorize and measure. Apart from in very young infants
(less than 6 weeks old), this parameter could serve as an
initial screening tool and to monitor bronchiolitic child in
the home.
If an infant has ingested at least half the usual amount
of food during the previous 24 hours, hypoxia is unlikely;
in contrast, if food intake falls below half the usual
amount, medical attention is required.
French version of the manuscript : “see Additional file 1”.
Additional file
Additional file 1: Bronchiolite et prise alimentaire des dernières 24
heures: un outil de dépistage de l’hypoxie (The French version of
the manuscript).
24h FI: Food intake during the previous 24 hours as a percentage of usual
intake; ACTIV: Association Clinique et Thérapeutique Infantile du Val de
marne, a research institute on pediatric community acquired infections;
CI: Confidence interval; LR
: Positive likelihood ratio; LR
: Negative likelihood
ratio; NPV: Negative Predictive Value; OR: Odds ratio; PPV: Positive predictive
value; RSV: Respiratory Syncitial Virus; SpO2: Saturation of hemoglobin with
oxygen as measured by pulse oxymetry.
Competing interests
All the authors declare that no financial support for the submitted work was
received from anyone other than their employer; that they have no financial
relationships with commercial entities that might have have an interest in
the submitted work in the previous 3 years; that they have no spouses,
partners, or children with financial relationships that may be relevant to the
submitted work; and that they have no non-financial interests that may be
relevant to the submitted work.
This work was submitted by ACTIV. The funders of ACTIV had no role in the
study design, data collection or analysis, the decision to publish, or the
preparation of the manuscript.
Authors’ contributions
Designed the study: FC FLR EM CW AE MK AW MB RC. MB designed the
data base. Enrolled patients: FC CW AE MK AW RC. Analysed the data: FC FLR
EM MK RC. Contributed to the writing of the paper: FC EM MK RC. Agree
with the manuscript’s results and conclusions: FC FLR EM AE MK AW MB RC.
All authors read and approved the final manuscript.
Authors’ information
François Corrard is a French pediatric and President of a research institute on
pediatric community acquired infections (ACTIV). His main research interests
Corrard et al. BMC Pediatrics 2013, 13:6 Page 6 of 7
are epidemiologic studies and clinical trials in community acquired
infections, including pneumococcal diseases, the rhinopharyngeal flora, and
vaccines. He has published more than 10 papers in English.
This work is dedicated to the memory of Claudie Wollner.
We thank the other investigating pediatricians (Christian Copin, Patrice
Deberdt, Solange Duriez, Geneviève Granat, Eric Sandrin, Anne-Sylvestre
Michot, Mohammed Benani, Allegra Brami, Jean Pierre Henon, Sydney
Sebban, Marie Hélène A’kou and Eric Osika), Philippe d'Athis for his statistical
expertise and Nicole Beydon for proof-reading the manuscript. None of the
physicians listed received any financial compensation for their contributions.
We thank all the patients and their parents who participated in this study
We also thank Corinne Levy, (ACTIV), Manuela Pereira (ACTIV), Sadia Tortorelli
(ACTIV) and Stéphane Béchet (ACTIV) for their technical assistance.
Author details
ACTIV (Association Clinique et Thérapeutique Infantile du Val de marne), 27
rue d’Inkermann, 94100, Saint Maur des fossés, France.
Physiology Lung
Function Department Armand-Trousseau Hospital, Paris, France.
of Microbiology, CHI Créteil, 40 avenue de Verdun, Créteil, France.
Received: 25 March 2012 Accepted: 8 January 2013
Published: 11 January 2013
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Cite this article as: Corrard et al.: Food intake during the previous 24 h
as a percentage of usual intake: a marker of hypoxia in infants with
bronchiolitis: an observational, prospective, multicenter study. BMC
Pediatrics 2013 13:6.
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